Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial

Background: Periodontal diseases and diabetes are two common diseases with high prevalence. Many clinicians have accepted the relationship between these two diseases. Some investigators have reported that periodontal treatment may enhance the metabolic control of diabetes. The effects of non‐surgical periodontal treatment on metabolic control in people with type 2 diabetes mellitus (DM2) were examined. Methods: Forty patients with DM2 and chronic periodontitis [mean age = 50.29 years; mean glycated haemoglobin (HbA1c) = 8.72] were randomly assigned to two groups. The treatment group (n = 22) received full‐mouth scaling and root planing, whereas the control group (n = 18) received no periodontal treatment. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), triglyceride (TG) and cholesterol levels were recorded at baseline and compared to data collected three months later. Results: The groups did not differ in gender ratio, age or clinical parameters [PPD (p = 0.107), CAL (p = 0.888), PI (p = 0.180)] and biochemical markers at baseline [FPG (p = 0.429), HbA1c (p = 0.304), TG (p = 0.486), TC (p = 0.942), LDL (p = 0.856) and HDL (p = 0.881)]. FPG, HbA1c and clinical parameters differed between the treatment and control groups (p = 0.006, 0.003 and 0, respectively). From baseline to follow‐up (after three months), HbA1c levels decreased in the treated group (p = 0.003). In the same time period, FPG, GI, PPD and CAL increased in the control group (p = 0.016, 0.0, 0.0 and 0.004, respectively) but HbA1c did not change significantly. Conclusions: Non‐surgical periodontal therapy could improve metabolic control in diabetic patients.     

Effectiveness of a nutraceutical agent in the non-surgical periodontal therapy: a randomized,controlled clinical trial

Clinical Oral Investigations - Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical...     

A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial

Clinical Oral Investigations - This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal...     

Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized,controlled clinical trial

Clinical Oral Investigations - This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach...     

Non-surgical periodontal therapy with and without subgingival minocycline administration in patients with poorly controlled type II diabetes: a randomized controlled clinical trial

The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus (T2DM) after non-surgical periodontal therapy. Twenty-eight poorly controlled T2DM patients were randomly assigned to treatment with scaling and root planning (SRP) and SRP + subgingival minocycline administration. Clinical parameters, including the probing depth (PD), bleeding on probing (BOP), plaque score (PS), clinical attachment level (CAL), and plasma interleukin (IL)-6, soluble receptor of advanced glycation end products (sRAGE), chronic reactive protein (CRP), and hemoglobin A1c (HbA1c) were measured before and after a 6-month treatment period. Significant changes in PD, BOP, PS, and CAL were found in both groups. The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group (−0.082, p = 0.033). Small changes in the log sRAGE level and log CRP level in plasma were found in both groups. IL-6 in the plasma increased in the SRP group, but slightly decreased in the SRP+minocycline group (0.469 pg/ml, p = 0.172). Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c, but had no significant effect on plasma levels of IL-6, CRP, or sRAGE in patients with poorly controlled T2DM. For patients with both periodontal diseases and diabetes, non-surgical periodontal treatments may be helpful in their diabetic control.     

A randomized controlled trial of a 2% minocycline gel as an adjunct to non-surgical periodontal treatment, using a design with multiple matching criteria

Graça MA, Watts TLP. Wilson RF, Palmer RM: A randomized controlled trial of a 2% minocycline gel as an adjunct to non-surgical periodontal treatment, using a design with multiple matching criteria.   Abstract .
Topical locally delivered minocycline is an adjunctive to non-surgical periodontal treatment, but there are few reported trials. Previous trials have reported differences between changes in probing depth in treatment and control groups, but no differences in probing attachment level. In the present study, 30 subjects were paired according to gender, age, ethnic group, smoking habits, and probing depths. Both groups received intensive oral hygiene education and root planing with local anaesthesia. Active or placebo gel was placed subgingivally at planed sites in each subject according to a double-blind protocol, immediately after instrumentation, and 2 and 4 weeks later. A periodontal examination was made with a constant force probe before instrumentation, and 6 and 12 weeks later. 2 subjects failed to complete the study, and their pairs were therefore not included in the analysis. Results were tested with analysis of covariance. Differences between groups in mean probing depth did not reach statistical significance at any visit (baseline: test (T)=5.93 mm, control (C)=5.74 mm; 6 weeks: T=3.53 mm, C = 3.63 mm; 12 weeks: T = 3.29 mm. C = 3.44 mm), but mean probing attachment levels were different (p<0.05) at both reassessments (baseline: T=6.86 mm, C=6.83 mm; 6 weeks: T=4.93 mm, C=5.30 mm; 12 weeks T=4.91 mm, C=5.27 mm). There was also a difference in the number of sites with bleeding on deep probing at 12 weeks (p<0.05). This trial showed that adjunctive minocycline gel provided a more advantageous outcome for nonsurgical periodontal treatment in terms of probing attachment level and bleeding on deep probing. This trial was a good example of experimental, as opposed to community, design, and used limited resources to show a clear result.     

Asepsis during periodontal surgery involving oral implants and the usefulness of peri-operative antibiotics: a prospective, randomized, controlled clinical trial

Objectives: This randomized clinical trial compares the usefulness of pre‐ and post‐operative antibiotics while strict asepsis was followed during periodontal surgery. Material and Methods: Two groups of 40 consecutive patients each with fully or partially edentulous jaws were enrolled. Antibiotics group (GrAB⁺): 23 men, mean age 60, 128 implants, received oral amoxicillin 1 g, 1 h pre‐operatively and 2 g for 2 days post‐operatively. Non‐antibiotics group (GrAB^?): 20 men, mean age 57, 119 implants, received no antibiotics. Bacterial samples were taken from the peri‐oral skin before and at the end of surgery. In 12 patients in each group, samples were also taken from the nares. A VAS questionnaire evaluated symptoms of infection/inflammation by both the patient and the periodontologist at suture removal. Results: There were no significant differences between both groups, neither for the clinical parameters nor for the microbiota. Staphylococcus aureus was detected in the nares of one patient only. The patients' subjective perception of post‐operative discomfort was significantly smaller in the group receiving antibiotics. Three patients lost one or two implants. Conclusions: Antibiotics do not provide significant advantages concerning post‐operative infections in case of proper asepsis. It also does not reduce peri‐oral microbial contamination. It does on the other hand reduce post‐operative discomfort.